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0111GINAL STATI OF ( 11 II OR\IA DWR USE ONLY — DO NOT FILL IN -� <br /> File with DWR WELL COMPLETION REPORT <br /> P.ti I of Her', !o Iuslrirrft,ui Puillphlrf STATE WELL NO)STATION NO <br /> Own(.r's Wdl No No 731140 ❑ <br /> I)It( WoI k Bit ti ill �It zkd(M C,IUP(1__�v F`^ Q❑ LATITUDE LONGITUDE <br /> Loc 11 P(I Ina At;i i <a V ZT1. At✓1 C,_.,U 1/14"I— APNl7RSlO THER <br /> P(1 nut No c3 f I'c,nut Da( j f Sc 10 <br /> `' GEOLOCIC LOC WELL OWNLR <br /> ORIENTATION (�) _VERTICAL —HORIZONTAL _ANGLE _(SPECIFY) Name <br /> DRILLING VI filing A(1dICS5 <br /> -P <br /> DEPTH FROM METHOD FLUID <br /> SURFACE DESCRIPTION �i,i 6,o <br /> FI to Ft De s(rtbC Miert(t 1((l �,1(trtl s1=( (olid e Ir CITY T STATE ZIP <br /> U iWELL OCATIOIN <br /> Addie,,,, � [z� lh]_ tn.,,Lncr Ytd1 <br /> Clth10 ci ` _ � <br /> APN Book IIT(- -"S_ P acct C' <br /> 0, ��' 0 S vzr� L- Towns1111) Range Sect,on <br /> 9 -----------�I 5 Lttttude i I NORTH Longd)L(1( I WEST <br /> DEG MIN SEC DEG MIN SEC <br /> LOCATION, SKETCIt ( f ) — <br /> C NORTH _ NEW WELL <br /> ' 1 Of V MODIFICATION/REPAIR <br /> Deepen <br /> b t i — Other(Specify) <br /> ' ' DESTROY fDesctrCe <br /> Procedures and Materials <br /> Under GEOLOGIC LOG, <br /> �-y + PLA\N,ED USES (�) <br /> WATER SUPPLY <br /> i i III/ <br /> 13S"N Dor,11i Public <br /> Y Irngahon Industrial <br /> � ' I <br /> LU 1n4i MONITORING V <br /> { TEST WELL <br /> CATHODIC PROTECTION <br /> HEAT EXCHANGE <br /> DIRECT PUSH _ <br /> lI INJECTION <br /> LA y�J VAPOR EXTRACTION <br /> SPARGING , <br /> i SOUTH REMEDIATION �. <br /> Illmhaft w Urunb, Distawe of 41i ll i ,ani Bowl, lirnIdw-s <br /> i i 1 i iur} lTii r,� rIr and attfu It a nugt [s, adeh rernnl 1p,i ,f OTHER(SPECIFY) <br /> ii[(f%mitt P1I-ASL RE A(DURA E(', LOMPLET <br /> WATLR LEVLL & IIELD OF COMPLETED WELL <br /> i DEPTH TO FIRST WATER _-1_ _..._.(Ft) BELOW SURFACE <br /> OEPTH OF STATIC i f ! {C� <br /> WATER LEVEL ! (Ft)&DATE MEASURED 1 to D <br /> ESTIMATED YIELD (GPM) & TEST TYP <br /> I M I1 1)I PFII 01 tiORIv (f•t t 11 TEST LENGTH {Hrs) TOTAL DRAWDOWN (Ft) <br /> roF11. DFPTII OE• (OMPI FTI 1) 11 ELL � (I c(t) "Alay not Gc IglzNurtatr,c 01(r wc11's 1011 1-7;1 )rnld <br /> DEPTH CASINC (S) DEPTH AN,N,UTAR MATERIAL <br /> FROM SURFACE BORE <br /> HOLE TYPE{ : ) FROM SURFACE TYPE <br /> DIA r z0 � MATERIAL/ INTERNAL GAUGE SLOT SIZE CE SFN <br /> (Inches) = w z� a GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> Fitto FI m �� J {Inches) THICKNESS (inches) Ft to F( ITYPFJSIZE) <br /> 'l � f O <br /> - �( o 01clo b <br /> ATTACIINIENTS (�L) CI RTII ICATION, S17111,11L\T <br /> I the under$Igned certify that this report Is complete and accurate to the best of my knowledge and belief <br /> _ Geologic Log 1 <br /> Well Conslrucuon Diagram NAME ` <br /> Geophysical Log(s) S-- <br /> {PERSON FIRM OR CORPORATION) (TYPED OR PRINTED) l•J\ <br /> SOUWaler Chemical Analyses v I r J <br /> Other ADDRESS ( CITY STATE IIP <br /> w <br /> ATTACH ADDITIONAL INFORMATION IF IT EXISTS Signed 7 <br /> wElt L 1pu ORIZED REPRESENTATIVE DAt )CNE C 57 LICENSE NUM9R <br /> I)\r R Iu III\ I I I- IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FOAM <br />